His duties required him to visit the prison every day, see every prisoner at least twice a week, visit all sick prisoners in the infirmary every day and to examine each new prisoner.

In one of his first reports in 1822, with the prison holding around 140 people, he listed ten people in his care, among them the pitiable Frances Bell, who had come into the prison with a diseased rectum.

But by 1836 the prison population had doubled and in his report of October that year he detailed some 28 people in the infirmary.

Accompanying his report was a letter to the Surrey magistrates, which noted that the increase in his workload had not been paralleled by an increase in his salary.

At the start of his tenure, he wrote, those coming into Brixton had generally had a ‘robustness of constitution’, but the knowledge of the care that the prison provided meant that more and more he was seeing those ‘in the most diseased and broken down state of constitution . . . in the extremity of destitution and distress’.

It meant, he said, that ‘instead of a place of punishment, this establishment is to those persons an asylum or hospital, affording a cure to their diseases and a relief to their wants.’

One of his principle duties was examining those who claimed to be unfit to labour on Brixton’s notorious treadwheels, ‘many of whom, when foiled in their attempts to deceive, are extremely troublesome and abusive, and I have been threatened with personal violence from many for reporting them fit for Labour.’

And he argued it was now common for him to act not so much as a doctor, but a midwife, such were the numbers of women on the verge of labour coming through the prison gates, which detained him ‘nights and days’.

He also lamented that the doctors in the other London prisons had higher salaries, despite having far fewer duties.

A transcription of Gardner’s letter, held in the Surrey History Centre, is below.

At the early period of the establishment of the Brixton House of Correction the Diseases that came under the care of the Surgeon were chiefly such as occur from the common existing causes and casualties in subjects possessing an ordinary state of health and robustness of constitution, but when the nature of the prison discipline and accommodation became known and appreciated by those who became its inmate, a class of Prisoners in the most diseased and broken down state of constitution, and in the extremity of destitution and distress have gained admittance into this Establishment exclusively for the purpose of obtaining medical relief and attendance and whose term of Imprisonment usually expires by the time they have recovered, so that, instead of a place of Punishment, this Establishment is to those persons an Asylum or Hospital, affording a Cure for their Diseases and a relief to their wants.

I have repeatedly shown to the visiting Magistrates that these cases are of a much more onerous and arduous nature than such as casually occur in healthy subjects, that they require much greater attendance, and oftentimes visiting twin in the same day, and involve a greater degree of responsibility; for independently of the calls of humanity, in case of the death of any of these Individuals, which not infrequently happens, a Coroner’s Inquest is summoned; where, if the slightest neglect is proved, the medical attendant becomes exposed to severe and public censure. It often happens too that at the expiration of the term of confinement, these Individuals are in such a debilitated and diseased state, that they are quite incapable of being removed, and sometimes they die within the walls of the Prison long after the Expiration of their sentence, and I should observe that, on the occasion of the Coroner’s Inquest, the Surgeon is always obliged to attend where he is often detain some hours.

At the first Establishment of the Brixton House of Correction Midwifery was, I believe, never contemplated; but for several years past I have had annually many cases of this description in the Prison, which have detained me nights and days.

The Surgeon is now called upon to attend likewise and report on the Health of the Officers of the Prison male and female and occasionally has visited them at some distance from hence. A great many Infants and Children are also confided to the case of the Surgeon, may of whom have been attacked with acute infantile disorders.

In addition to my attendance upon the sick, a large portion of my time is usually occupied every day in examining upwards of twenty prisoners who simulate disease in order to avoid the labour of the wheel, and these cases frequently require more investigation that those of real Disease – Indeed I have always felt this the most mortifying and painful part of my Duties, as it brings me daily into collision with some of the most determined and successful Impostors, many of whom, when foiled in their attempts to deceive, are extremely troublesome and abusive, and I have been threatened with personal violence from many for reporting them fit for Labour.

I beg leave also to submit to your Consideration another source from which a great deal of heavy responsibility devolves upon me and which constantly requires vigilant and discriminating attention. This arrives out of our system of Prison Discipline, and more particularly the Dietary which necessarily reduces the strength and weight of every male Prisoner. This may be carried to a certain extent, but no farther, without reducing the constitution of the Prisoners to a critical state, whereby he becomes the subject of Disease; and in which case, if attacked by any of the common conditions his life is often in peril, and his complaints more difficult to cure than those of an ordinary Individual. Indeed if there are some constitutions that will not bear the effect of the Prison discipline, and, as connected with such persons if its strictness were not abandoned, the consequences would be fatal. These inmates are not speculative, they are facto derived from experience, and the result of observations I have made in the cause of my professional attendance at the Prison.

The number of Prisoners has increased I believe of late years considerably.

Lastly I believe that on enquiry, it will be found that at all the Tread Mill Prisons about the Metropolis viz the Millbank Penitentiary, Tothill Fields and Cold Bath Fields, the Surgeons Salary is much greater comparatively than at Brixton, with no Duties of a more arduous nature than mine within their several Prison, on the contrary in many instances they are less so, and in being exempt from attendance at the Quarter Sessions four times in the year they are saved from what is a necessary cause of great expense and anxiety to me, and any allowance for travelling expenses has for some years been discontinued.